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Associations between birth characteristics and eating disorders across the life course: findings from 2 million Swedish males and females born 1975-1998
Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, United Kingdom.
Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).ORCID iD: 0000-0002-7034-1922
2013 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, p. 108-109Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Introduction

Results on developmental origins of eating disorders (ED) have been conflicting, with low power in many studies. We studied the effect of birth characteristics including twin/triplet status; gestational age; birthweight; birthlength; delivery method; Apgar score; birth traumas; mother’s smoking and weight gain during pregnancy.

Methods

From a total population data, we created a cohort of 2,011,908 males and females born to Swedish-born mothers in Sweden 1975-1998. We adjusted for multiple family and social characteristics, and conducted within-family analyses to test for family-level confounding. Outcomes were hospitalisation for anorexia, bulimia or ‘eating disorder not-otherwise-specified’ after age 12, with follow-up to end 2010.

Results

Anorexia was independently predicted by multiple birth (adjusted hazard ratio (HR) 1.33 (95%CI 1.15-1.53) for twin/triplet vs. singleton) and by lower gestational age (HR 0.96 (0.95-0.98) per extra week of gestation). These associations were specific to anorexia, and were only seen in the cohort members affected – within-family analyses revealed that the maternal siblings of twins or preterm individuals showed no increased risk. Higher birthweight for gestational age showed a strong association with bulimia (HR 1.15 (1.09-1.22) per sex-standardised standard deviation increase). This association was specific to bulimia and within-family analyses provided no evidence of residual family-level confounding.

Discussion

Our findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia. Further research is needed to elucidate the mechanisms, but the dose-response nature of these associations indicates that they do not simply reflect pathological responses at the extremes of the distribution. The strong association with multiple births is noteworthy as many of the best population-based studies of ED prevalence have been conducted in twins and might thus have overestimated ED prevalence.

Key messages

  • Our findings are consistent with a causal role of earlier gestational age upon anorexia and higher birthweight upon bulimia.

  • Anorexia was independently predicted by multiple birth.

Place, publisher, year, edition, pages
2013. Vol. 23, p. 108-109
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:su:diva-97002DOI: 10.1093/eurpub/ckt126.267OAI: oai:DiVA.org:su-97002DiVA, id: diva2:668436
Available from: 2013-11-29 Created: 2013-11-29 Last updated: 2022-02-24Bibliographically approved

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Heshmati, AmyKoupil, Ilona

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